• 보건행정학회지
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• 제24권1호
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• pp.24-34
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• 2014

Background: Bankrupted households have recently been increased due to excessive medical expenditure in Korea. They have not been protected from economic risk when household's member has severe diseases that need a lot of money for treatment. Purpose of this study examines policy effect by comparing unmet needs' change of policy object households and non-object groups. Methods: We used Korea Health panel 2nd 4th data collected by Korea Institute for Health and Social Affairs and National Health Insurance Service. Analysis subjects were 381 households (pre-policy) and 393 households (post-policy) that had cancer and cardiovascular and cerebrovascular diseases. Since it was major concern that estimates benefit strengthening policy started by certain time, we setup comparing households which had diabetes, hypertension disease. Comparison subjects were 393,247 households, respectively and we evaluated policy effect using difference in difference (DID) model. Results: Although unmet needs of policy object households were higher than non-object groups, policy execution variable affected negative direction. But interaction-term which shows pure effect of policy was not statistically significant. We utilized multi-DID model to examine factors affecting unmet needs causes. Copayment assistance policy did not significantly affect households that responded to 'economic reason,' and 'no have time to visit' for unmet needs causes. Conclusion: The second copayment assistance policy did not significantly give positive effect to beneficiary households than non-beneficiary groups. When we consider that primary purpose of public insurance guarantee high medical expenditure occurred by unexpected events, it needs to deliberate on switch of benefit strengthening policy that can assist vulnerable people. Also, we suggest that government forward a policy covering non-reimbursable medical expenses as well as switch of benefit strengthening direction because benefit policy do not affect non-covered medical cost which accounts for quarter of total health expenditure.

• 대한예방한의학회지
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• 제1권1호
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• pp.137-148
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• 1997

The Serial Securities and the Social Welfare, as the national policy aimed at securing generals' lives, are the policies or systems for the stabilization in lift; especially of law-incomers and workers, for which the povernment has to establish the Social Security System. No wonder the Social Insurance System is a part of the Social Security System and the most important. The Social Insurance System, along with Public Assistance, is underlying the Social Security System. Social Security System includes medical insurance, industrial accident Compensation insurance, national pention insurance and employment insurance. The study is on 'The Oriental Medical Insurance and the Industrial Accident Compensation in the Social Security System' . The rate of industrial accident in Korea marks the highest rank in the world. for laborer, industrial accident do not merely mean the loss of health but the question of the right to live in terms of their loss of opportunity of life. The industrial accident compensation system should be established as the es post facto remedy system to guarantee the injured worker and his/her family's life. The oriental medical insurance system which began to operate in 1987 in Korea is based on unionism and divided into 3 parts; one part for the worker, a second part for the community inhabitants, and a third part for the public service personnel and private school personnel. Today the medical problem must be the most important social assignment to be considered. The medical system of contemporary industrial society has began greatly stood out in relief as a part of social welfare not emphasized on gainings of physicians. Accordingly systematization of the oriental medical insurance was strongly Pursued and it was developed to to the extent of entire nation insurance. Though the history of it is very short, most of the people are getting benefit from the insurance system by the social security system method. This study develops the Oriental Medical Insurance, the Workmen's Accident Compensation Insurance, the Pension System in relation to the industrial accident compensation of Employees, along with the ideas and principles of social insurance.

• 보건행정학회지
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• 제31권3호
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• pp.344-354
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• 2021

Background: The purpose of this study was to analyze the effect of national health insurance coverage of Chuna therapy in April 2019 on the costs and service uses in automobile insurance. Methods: This study used the claim data from Health Insurance Review and Assessment Service. A total of 189,912 inpatients and 1,550,497 outpatients who received Chuna therapy covered by automobile insurance in oriental medical institutions were included. The analysis period was from July 2018 to December 2019, and a total of 18 months before and after April 2019, when Chuna therapy was covered by national health insurance. Interrupted time series analysis was applied to analyze the impact on the costs and service uses of Chuna therapy in automobile insurance before and after April 2019. Results: From July 2018 to December 2019, for 189,912 inpatients the cost and the number of times for Chuna therapy per capita were increased by 22.0% and decreased by 7.3% respectively right after the implementation of the policy. In the case of 1,550,497 outpatients, the cost of Chuna therapy per capita tends to be increased by 0.4% in overall study periods and increased 28.4% immediately after the implementation of the policy. Meanwhile, the number of times and visits for Chuna therapy per capita tends to be increased by 0.4% in overall study periods but decreased by 0.4% after the implementation of the policy. Conclusion: Results suggest that if the national health insurance coverage of oriental medicine services increases according to the policy stance for benefit expansion in national health insurance, the criteria for providing national health insurance benefits should be considered with the comprehensive impacts on the costs and service uses of automobile insurance.

• 보험의학회지
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• 제27권1호
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• pp.33-36
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• 2008

BACKGROUND : The medical claims review(MCR) is unique methodology of medical consultation in terms of insurance claim administration in Korean insurance market. The most important practical matter in the MCR is formatted question. In Korea, medical specialty is composed of 26 legally defined hospital departments. It is worth of studying to investigate type of MCR by hospital departments. METHODS : Fifty Cases of the MCR were selected randomly by statistical program SPSS among 1,032 cases which were performed between April 1, 2006 and March 31 2007. All of selected cases were evaluated one insurance doctor and made a score points from 0 to 10 in terms of hospital department. RESULTS : Multidimensional scaling was performed. The MCR types - diagnosis, malignancy and cause of death are located in the same 2-dimensional configuration area. It can be called as verification of benefit. Others are advice. - such as causality, interpretation, translation, independent medical examination, and so on. DISCUSSION : We can conclude the classification of MCR typology are two main subjects, verification and advice. Theses results are same as previous article which was based on experience.

• 보험의학회지
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• 제29권1호
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• pp.16-21
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• 2010

The measurement of prostate specific antigen (PSA) in screening for prostate cancer is recently performed as a routine check-up in clinical medicine and insurance medicine. Several factors may affect serum PSA levels. As prostate size increases with increasing age, the PSA concentration also rises. Increasing body mass index (BMI) is associated with a lower mean PSA concentration. Inhibitors of 5-alpha-reductase such as finasteride and dutasteride produce a 50 percent or greater decrease in serum PSA during the first three months of therapy, which persists as long as the drug is continued. Men who are regularly taking non-steroidal antiinflammatory drugs (NSAIDs) or acetaminophen have lower PSA levels. Emerging concepts regarding PSA testing that may help refine the interpretation of an elevated concentration include: PSA density, PSA velocity, and Free versus complexed or bound PSA. With many insurance companies, PSA level has become part of a standard battery of blood tests, along with HIV, cholesterol, liver enzymes, and other predictors of premature death. But, there is no clear proof of benefit, so we have to monitor the value of PSA test as a prostate cancer screening test in insurance medicine.

• 무역상무연구
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• 제27권
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• pp.129-161
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• 2005

Todays, computers in business world are potent facilitators that most companies could not without them, while they are only tools. They offer extremely efficient means of communication, particularly when connected to Internet. What I stress in this article is the risks accompanied by e-commerce rather than the advantages of Internet or e-commerce. The management of e-commerce companies, therefore, should keep in mind that the benefit of e-commerce through the Internet are accompanied by enhanced and new risks, cyber risks or e-commerce risks. For example, companies are exposed to computer system breakdown and business interruption risks owing to traditional and physical risks such as theft and fire etc, computer programming errors and defect softwares and outsider's attack such as hacking and virus. E-commerce companies are also exposed to tort liabilities owing to defamation, the infringement of intellectual property such as copyright, trademark and patent right, negligent misrepresent and breach of confidential information or privacy infringement. In this article, I would like to suggest e-commerce insurance or cyber liability insurance as a means of risk management rather than some technical devices, because there is not technically perfect defence against cyber risks. But e-commerce insurance has some gaps between risks confronted by companies and coverage needed by them, because it is at most 6 or 7 years since it has been introduced to market. Nevertheless, in my opinion, e-commerce insurance has offered the most perfect defence against cyber risks to e-commerce companies up to now.

• 통상정보연구
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• 제7권3호
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• pp.27-51
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• 2005

Todays, computers in business world are potent facilitators that most companies could not without them, while they are only tools. They offer extremely efficient means of communication, particularly when connected to Internet. What I stress in this article is the risks accompanied by e-commerce rather than the advantages of Internet or e-commerce. The management of e-commerce companies, therefore, should keep in mind that the benefit of e-commerce through the Internet are accompanied by enhanced and new risks, cyber risks or e-commerce risks. For example, companies are exposed to computer system breakdown and business interruption risks owing to traditional and physical risks such as theft and fire etc, computer programming errors and defect softwares and outsider's attack such as hacking and virus. E-commerce companies are also exposed to tort liabilities owing to defamation, the infringement of intellectual property such as copyright, trademark and patent right, negligent misrepresent and breach of confidential information or privacy infringement. In this article, I would like to suggest e-commerce insurance or cyber liability insurance as a means of risk management rather than some technical devices, because there is not technically perfect defence against cyber risks. But e-commerce insurance has some gaps between risks confronted by companies and coverage needed by them, because it is at most 6 or 7 years since it has been introduced to market. Nevertheless, in my opinion, e-commerce insurance has offered the most perfect defence against cyber risks to e-commerce companies up to now.

• 보건행정학회지
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• 제24권2호
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• pp.181-190
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• 2014

Background: Demands are recently rising for the securement of procedural justification of policy decision-making. This study aims to improve the procedure of making a decision to expand health insurance benefit package from the perspective of building a social consensus. Methods: Major priority principles were firstly derived through literature search. Weights for such principles were calculated through an analytic hierarchy process, based upon the survey conducted for the health policy experts. Priority for 11 non-covered services was assessed by applying the weights as above to the results of the questionnaire survey targeted at people including members of related committees or societies. Results: Weights for priority principles were in the order of 'severity/urgency (0.428)', 'cost-effectiveness (0.318)', 'substitutability (0.164),' and 'accountability (0.090)'. What was obtained by applying these weights to the results of the questionnaire survey was considerably in line with what health experts classified those items into 3 groups depending on their own judgement of service necessity (consistent with 9 services out of 11). Conclusion: Results of the study are suggestive as to how far a brief assessment by experts could be utilized in case there are constraints on time and expenses in implementing all the process to secure procedural justification. Various attempts and endeavors need to be made to secure procedural justification that will not mar efficiency of decision-making in the days to come.

• 한국치위생학회지
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• 제15권5호
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• pp.899-905
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• 2015

Objectives: This study aimed to investigate the regional difference of chronic periodontal care services in Korea by the analysis of 2010 raw data from Health Insurance Review and Assessment Service. Methods: The subjects were the chronic periodontitis patients over 35 years old from dental care facilities in Korea. The study population was 278,319 including 264,994 claims made by dental clinics, 8,084 by dental hospitals, 3,509 by general hospitals, and 1,732 by tertiary hospitals. Results: There was a significant difference in medical care cost benefit between the provinces(p<0.0001). The age groups showed a clear difference in the patient charge, cost of insurance, and medical care cost benefit(p<0.0001). In consideration of the first visit or revisit, there were differences in the rate of prescription, dental examination, and surgical procedures of the chronic periodontal patients from dental facilities. The radiographic use rate in the tertiary hospitals was 2.6 times higher than that of the dental clinic in the treatment of the new chronic periodontal patients. Conclusions: The use of dental services in the periodontitis is influenced by the types of medical services facility, cost of medical insurance, and patient charge. In consideration of cost benefit analysis, prevention is the most important care for the periodontitis. Regional difference in peridontitis is cause by the use of medical services and quality of treatment.

• 한국항해항만학회지
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• 제32권3호
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• pp.237-244
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• 2008

국제노동기구는 2006년 2월23일 해사노동기준에 관하여 그 동안의 협약 및 권고를 가능한 한 최신화 하고 모든 기준을 통합하여 단일의 문서로 된 해사노동협약을 채택하였다. 이 협약은 제4편 규정 제4.5조에 선원에게 적용되는 사회보장에 관하여 규정하고 있다. 규정 제4.1조 선내 및 육상에서의 의료관리, 규정 제4.2조 선박소유자의 책임에 관한 조항도 사회보장과 관련되어 있다. 우리나라가 이 협약을 비준하기 위하여서는, 우선 먼저 국내 관련법령이 협약상 선원 사회보장 요건을 충족할 수 있는지를 검토하고, 불충분한 부분에 대하여는 이를 정비할 필요가 있다. 따라서 이 연구에서는 협약상 선원의 사회보장에 관한 요건을 수용할 수 있도록 현행 국내 관련 법령과 협약 사이의 차이점을 밝히고, 이 과정에서 도출된 문제점에 관하여 그 해결 방안을 제시하고자 한다.